Alcohol use

The main features of alcohol withdrawal include:

• nausea and vomiting
• headaches
• abdominal pain
• fatigue
• high temperature and/or chills
• unpleasant, vivid dreams
• tics and tremors (‘the shakes’)
• irregular or increased heart rate
• excessive sweating
• shaking and shivering
• decreased appetite
• depression
• anxiety
• insomnia
• mood swings
• confusion
• irritability and agitation
• difficulty concentrating
• intense cravings for alcohol (Fernandez, 2012)

The most severe symptoms of alcohol withdrawal syndrome are called delirium tremens, occurring in around 3–5% of people experiencing withdrawal, and are potentially life threatening (Fernandez, 2012).

The symptoms of delirium tremens include:

• severe disorientation and confusion
• extreme agitation
• visual and/or auditory hallucinations
• seizures
• fever
• high blood pressure (Fernandez, 2012)

Every person will have a unique experience when going through alcohol withdrawal. The symptoms, their severity and the risk that they pose will depend on personal history as well as physical and mental health. If a person presents with severe withdrawal symptoms, they should be

The causes of harmful or dependent alcohol consumption are multifactorial, and can involve:

• genetics
• parenting
• peer and societal norms
• pharmacology
• mental health

Other prevalent causes include:

Depression, bipolar disorder and associated mental health issues (eg anxiety and stress): low mood or a fluctuating mood can result in excessive alcohol consumption for self-medication. Many people struggle to maintain treatments such as psychotherapy.

Social factors: people who are experiencing poverty and low socioeconomic status, unemployment or homelessness are more vulnerable to higher rates of alcohol consumption and dependency.

Family: often children and young adults who have grown up with adults who consume harmful amounts of alcohol can repeat this behavioural pattern when they grow into adulthood.

A person with potentially harmful alcohol use will be assessed with a series of questions focusing on the patterns and frequency of alcohol intake. Daily alcohol consumption will lead to a person being classed a dependent drinker. A person who consumes 10–20 units per day over a few days will normally be classed a binge or episodic drinker.

The Audit C scoring tool consists of questions from the full alcohol use disorders identification test (AUDIT). When completed, the score illustrates the level of risk of the person’s alcohol consumption habits.

Audit-C scoring:

• ≥5 is a positive screen
• 0–4 indicates low risk
• 5–7 indicates increasing risk
• 8–10 indicates higher risk
• 11–12 indicates possible dependence

While identification and brief interventions may be helpful to reduce risk for those who have a non-dependent pattern of alcohol consumption, the National Institute for Health and Care Excellence guidance (2011) suggests that adults who have dependency require behavioural counselling using motivational interviewing or cognitive behavioural therapy as part of a package of care.

Identification and brief interventions

Identifying a person’s alcohol health risk and explaining this to them along with some advice on cutting down consumption is often effective in reducing alcohol use. This can enable the person to reflect on their alcohol consumption, which increases their awareness and insight into their pattern of use, empowering them to make changes to their intake (Office for Health Improvement and Disparities, 2023).

Identification and brief interventions can reduce alcohol consumption for hazardous and harmful consumption; however, longer duration interventions offer additional benefits (Office for Health Improvement and Disparities, 2023).

Motivational interviewing

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages.

Part 2: Procedures for the planning, provision and management of person-centred nursing care

3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation

British National Formulary. Alcohol dependence. 2023. https://bnf.nice.org.uk/treatment-summaries/alcohol-dependence (accessed 4 January 2023)

Department of Health and Social Care, Office for Health Improvement and Disparities. Chapter 12: alcohol. 2023. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-12-alcohol (accessed 4 January 2024)

Fernandez J. Nurse-led detoxification in primary care. Can it be done? Journal of Research in Nursing. 2012;17(1):66-75. https://doi.org/10.1177/1744987110379788 

National Institute for Health and Care Excellence (NICE). Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. 2011. https://www.nice.org.uk/guidance/cg115 (accessed 4 January 2024)

NHS Digital. Statistics on alcohol, England 2021. 2021. https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2021 (accessed 4 January 2024)

Office for Health Improvement and Disparities. Alcohol and drug misuse and treatment statistics. 2023. https://www.gov.uk/government/collections/alcohol-and-drug-misuse-and-treatment-statistics (accessed 4 January 2023)

World Health Organization. Alcohol. 2022. https://www.who.int/news-room/fact-sheets/detail/alcohol (accessed 4 January 2024)